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Postpartum Hemorrhage

After birth

Step 1: View clinicals

A 31 year old primipara at full term delivered a healthy baby vaginally, following an uncomplicated labor. The placenta was delivered completely, following which prophylactic oxytocin was administered. An episiotomy was not performed. When reassessed 30 minutes after delivery, she was found to be bleeding heavily. Her pregnancy had been uneventful, and her medical and surgical histories were unremarkable.

Step 2: Order all relevant investigations

Group & Cross-match Blood

Blood group: A+ve 4 pints of blood cross-matched

Coagulation screen

INR: 1.0 (normal: 0.9 - 1.3) APTT: 32s (normal: 24 - 35 in third trimester) TT: 14s (normal: 13 - 15) S. Fibrinogen: 300 mg/dl (normal: 200 - 400)

Full Blood Count

WBC/DC: 6,300/mm3 Hb: 9.7 mg/dl Platelets: 330,000/mm3

Bedside Ultrasound Abd+Pelvis

There is no evidence of retained intrauterine tissue. There is no free fluid in the abdomen.

Step 3: Select appropriate management

Transfuse Blood
Oxytocin infusion
IV Antibiotics

Score: ★★☆